ARC Journal of Nephrology Volume 2, Issue 2, PP 8-13 www.arcjournals.org

A Brief Histoical Survey of Movements (from the most ancient civilizations to Harvey and Malpighi)

S. Musitelli1*, M. A. Bertozzi2 1Expert of the History Office of the E.A.U. (European Association of Urology) Italy I dedicate also this article to the memory of my adored son Giulio, who was killed on May 14, 2012 by a criminal driver, who did not observe a STOP sign 2Head of the operative complex Department of Andrology at the Azienda Ospedaliera Pisana (Hospital Authority of Pisa – Italy)

*Corresponding Author: S. Musitelli, Expert of the History Office of the E.A.U. (European Association of Urology) Italy, Email: [email protected]

Abstract: Not even the faintest allusion to blood movements may be found either in any of the most ancient and more or less ample medical texts (Egyptian papyruses, Mesopotamian tablets, Chinese and Indian medical treatises, etc.) or even in the Corpus Hippocraticum. (384-322 B.C.) himself did not distinguish the from the . The first anatomist who realized this fundamental difference was Praxagoras of Cos (flourished in the 2nd half of the 4th century B.C.) – Aristotle’s son in low and Herophilus’ teacher – who observed that the arteries pulse whilst the veins do not. He maintained that the veins contained blood and the arteries air. The same opinion was advocated by his disciple Herophilus (1st half of the 3rd century) and his a little younger colleague and was only demolished by (129-c.199 A.D.), who succeeded in proving that arteries too contained blood, although the arterial one was red, whilst the venous one was rather blackish. However this exceptionally important discovery did not suggest to him even the faintest idea of blood circulation, or rather forced him to conceive a quite absurd anatomo-physiological theory, which lasted at least till the 17th century. The real problem was the following: where did ever go the breathed air if not into the arteries? This fundamental problem could be solved neither by him nor by any of all the subsequent anatomo-physiologists owing to the lack of any chemical knowledge. Even (1578-1657), who hypothesized for the first time in the history of the Western anatomo-physiology the complete “blood circulation”1 and (1628-1694), who finally proved it, could succeed in realizing what really happened in breathing. The problem was at last solved by the chemist Antoine Laurent Lavoisier (1742-1794), the founder of modern Chemistry.

A BRIEF AND NECESSARY INTRODUCTION medical papyruses, in some of the most ancient We must have recourse to the term passages of the Avesta (the sacred book of “movements” because every “circulation” is ancient Persia), in the surely archaic passages surely a “movement”, but not every of the Indian medical collection called “movement” is a “circulation” and the correct th and final idea of “blood circulation” only Ayurveda (about the 5 century B.C.), in the started in the 17th century2 most ancient Chinese medical treatise called Huang Ti Nei Ching su Wên (The canon of 1 – Not even the faintest description of the blood movements can be found either in the internal of the Yellow Emperor) rather alleged “medical texts” of the ancient (about 1000 B.C. if not more than 2.000 B.C.), as well as in the Indian medical treatises Mesopotamia, or in those of the Ancient Egypt, 3 or in those of the most ancient Persian, Chinese preserved with the names of Suçruta and 4 nd and Indian cultures. Indeed in some Assyrian Caraka (2 century A.D.) – the Suçrutasamhita and Babylonian tablets, in the ancient Egyptian (Suçruta’s path) and Carakasamhita (Caraka’s path) – one can find a lot of more or less correct, 1Although the “lesser circulation” was already more or less ample and more or less fanciful described by the Arab anatomist Ibn al-Nafis (1213- descriptions of blood vessels, this is true, but 1288) in his Sarah Tashrih al-Qanun Ibn Sina no allusion to any blood movement, let alone to (Commentary on Avicenna’s Canon). 2 the difference between arteries and veins. The Even in spite – as we shall point out below - of the first anatomist who realized this fundamental discovery and description of the valves of the veins by Giovanni Battista Canano (1515-1579), Amatus difference was Praxagoras of Cos – Aristotle’s Lusitanus (1511-1568) and finally and most son in low and completely by Gerolamo Fabrizi of Acquapendente 3Read “ç” like in “shame”. (c.1533-1619) [2]. 4Read “C” kike in “church”.

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Herophilus’ teacher – who observed that the 3) that blood derived from the different arteries pulse whilst the veins do not. He elaborations of the food. maintained that the veins contained blood and According to Galen – as well as to all the the arteries air. The same opinion was previous and subsequent anatomo- advocated by his disciple Herophilus and physiologists till at least the 17th century – the mainly by Erasistratus. food, first elaborated in the mouth, was 2 – Neither (c.469-399 B.C.), nor “attracted” by the stomach, transformed into Aristotle himself – as said above - chyme, expelled towards the bowels, which in distinguished the arteries from the veins. By their turn attracted and transformed it into contrast Praxagoras, Herophilus and chyle; the chyle expelled by the bowels was Erasistratus were aware of this fundamental attracted by the , which transformed it into difference although all of them made the great venal blood, charged it with “natural spirit” – mistake of maintaining that the veins contained which bestowed the power of growth and blood whilst the arteries contained air. Galen nutrition – and expelled it, which, in its turn, in his turn, succeeded in proving that the was attracted by the veins and sent to and arteries too contain blood. attracted by all the “parts” of a living body. The venal blood reached the left ventricle of the In his brief but most important treatise “An in , filtered through the interventricular arteriis sanguis contineatur”(Whether the septum – which was thought to be pervious –, arteries contain blood)[1] he describes how he transformed into arterial blood and charged could realize this discovery that was on the one with “vital spirit”, which, in its turn, provided hand fundamental, but on the other hand really all the different parts with activity. The arterial catastrophic for his anatomo-physiological blood, after having reached all the parts, went system. He bared and incised an of a up to the cerebellum or better the so called living animal and could see blood spurting out. “rete mirabile” (exquisite net) – a sort of However Herophilus’ and Erasistratus’ network consisting of blood capillaries6 – followers5 objected against his statement as which transformed it into “animal spirit” follows: as Nature is characterized by the initiating motion and sensation and reaching all “horror vacui” (horror for empty), you could the parts through the “” that were not see the spurting out air; indeed the venal considered as a third vascular system! blood runs immediately to fill the voided artery and this is why you erroneously imagined that It is clear that, according to this absurd this blood was formerly contained into the physiology, the whole mass of the blood, incised artery. At this point Galen tied up – finally transformed into “spirit”, vanished – so again “in vivo” – a tract of artery at both the to say – and this explained why every living distal and the proximal point so that no venal body, obviously man included, was constantly blood could reach the tied up tract This done, forced to restore it by nourishment. he incised again it between the two knots and Galen’s anatomo-physiological system may be succeeded in showing the blood spurting out! correctly summarized in the following drawing This proof was absolutely incontrovertible!! (Fig. 1) 3 – However this really astonishing anatomical procedure and the consequent no less astonishing consequence caused a disaster to his anatomo-physiological system. Indeed he could no more succeed in understanding which would ever be the task of the breathed air and was forced – as said above – to create his absurd anatomophysiology. He, as well as all the previous physicians and anatomists, were perfectly aware that: 1) the blood was necessary for living; Fig1: Observe that the right kidney is erroneously 2) by consequence the total loss of blood was considered as higher than the left according to Aristotle’s mistake! (after Ch. Singer and E. absolutely deadly;

6 5Who were aware of the existence of a capillary Which does not exist in the human brain but can be anastomotic network joining arteries and veins. only found in the brain of the Ungulata!

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Ashworth Underwood, A short History of Medicine, Oxford, at the Clarendon Press, 1962, p.54)7. 3 – And the breathed air? Which would it be its task? Simple: as said above, the food descended into the stomach, which was considered to be a sort of “cooking pot” where the food was “concocted” and transformed into chyme thanks to the “natural heat” of the heart, which acted like a cooker. In order to prevent the chyme from being burnt, the auriculae cordis acted like fans and moderated the otherwise too flaming “natural heat”! Useless to emphasize that: 1) these are nothing but a lot of real nonsense!

2) the centrifugal movement of the blood could be only caused by the not yet Fig2: The front page of Fabrizi’s Opera Anatomica acquired knowledge of the “valves” of the (A. Meglietti, Padua, 1625) containing the final veins, which just prevent the blood from edition of his booklet any centrifugal movement! 5 – Fabrizi’s booklet is provided with 8 4 – At last Gerolamo Fabrizi (or Fabrici) of marvellous copper engraved plates, but he let Acquapendente (c. 1533-1619)8 published his his disciple Salomon Alberti (1540-1600) brief but fundamental treatise De venarum publish in 1585 [4] a first description of the ostiolis (On the valves of the veins) [2] in 1603 valves provided with two xylographies (Fig. 3 (Fig. 2). We say “fundamental” because it and Fig. 4). paved the way to William Harvey9 and therefore to the final acquisition of “blood circulation”10 in spite – as we shall see be below – of his misinterpretation of the real function of the finally and perfectly described valves.

7This mistake will be corrected by Realdo Colombo (1516-1559) (who also re-discovered and described the “lesser blood circulation”) and his disciple Juan Valverde de Amusco (c.1525-c. 1587), who agreed with his master’s observations concerning both the position of the kidneys, and the “lesser blood circulation”. Concerning the position of the right kidney advocated by Galen it is worth reading

Colombo’s satiric passage in book XI, 9 of his treatise [3]: “It is exceptionally interesting that Fig3 (left) and Fig4 (right): Alberti’s two Galen fretted to inquire why Nature placed the right xylographies with the pertinent captions [3] (after kidney higher than the left. As a matter of fact our F. Grondona [2]). good Galen busted a lot – not to say in vain - about 5 – Alberti’s plates are clearly rather rough. By this fact because everyone could realize the entire contrary on the basis of simple experience!” contrast Fabrizi’s copper engraved ones are 8He held the chair of Surgery and at the really marvellous and nearly perfect as University of Padua from 1600 to 1613. everyone may realize if only takes a look of 9Who most probably reached Padua as a student just few of them. There is no doubt that most at the beginning of 1598, was one of Fabrizi’s and interesting is the first because – as we will see Galilei’s disciples and graduated in 1602. 10 below – it was repeated and obviously Although hypothesized by Harvey and – as said modified and improved by William Harvey above – finally proved by Malpighi. (Fig.5).

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paved the way – as said above – to William Harvey hypothesis concerning the complete blood circulation12. 6 – How could Harvey conceive the complete blood circulation? In order to solve this problem one must remember that he studied at Fig5: The 1st figure of the 1st plate of Fabrizi’s the University of Padua and attended not only treatise. of Fabricius of Aquapendente’s lessons on Anatomy and Surgery, but also and mainly However in order to realize the really Galilei’s lessons on Mathematics and Physics astonishing perfection of Fabrizi’s figures let and surely embraced the fundamental us add the following 4 plates (Fig. 4, Fig.6, principles of the “Galilean scientific Fig. 7 and Fig. 8): revolution”, which replaced the Aristotelian and Galenic “qualitative” and therefore “animistic” and “finalistic” perspective with the “quantitative” and therefore “mechanic” one [5]. By consequence his reasoning could be only the following: the average amount of the blood contained in the blood vessels is Kg. 6,5= pounds 14,444; its movements occur in about 1 minute; therefore during 24 hour they occur in 1.440 minutes. By consequence the total blood mass that moves in 1.440 minutes corresponds to Kg. 9.360 = pounds 20.800. But should the whole blood mass “vanish” transformed into spirits and be restored by the food, a man would not eat less than pounds 20.800 per day in order to avoid dying! Should the facts occur so, why a man could ever survive only eating at least pounds 4 of flesh and pounds 3 of bread? Yet he survives although eating a so little amount of food and – of course – drinking a not at all great amount either of water or of wine! 12However it is worth observing that not only Fabricius of Acquapendente paved the way for Harvey, but also Andrea Cesalpino (1519-1603), who was the first to dethrone – so to say – the liver and to put the heart at the origin of the arterial Fig. 4, Fig.6, Fig. 7 and Fig. 8: Fabrizi’ plates system. However it is a historical mistake to No doubt Fabrizi’s descriptions and consider him as the first discoverer ob blood illustrations are nearly a real masterpiece. circulation. Indeed his statement that “fugit sanguis However he did not understand at all the real ad cor” (the blood runs towards the heart) does not at all allude to any “blood circulation” but simply function of the valves and having correctly points out what we call “a thumb in the heart”, observed that they all – simple and double which occurs in cases of a sudden fright, as according to the thinner or wider – were Cesalpino himself explains: “circa metum 11 just placed a little below the start of a lateral fugit...sanguis ad cor verlut ad suum principium” venous branch, he – as a still faithful “galenist” (in cases of a sudden fright the blood runs towards – thought that they were a sort of brakes, the heart as towards its origin)! The same must be whose task was preventing the blood from said about the alleged description of “blood flowing too quickly and let it enter the circulation” by Miguel Servet (Latinized as lateralbranches of the veins! At any rate, his Servetus) (1511-1553). Indeed in his Christianismi final and discovery and description of the venal restitutio (Restoration of Christianity,) one can only find a sort of gimcrack mixture of blood, spirits and valves Holy Ghost that has absolutely nothing to do with 11Obviously “start” to him, but “insertion” to us! science, let alone with anatomo-physiology!

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7 – What does this mean? Obviously that only master Giovanni Alfonso Borelli (1608-1679) a little part of the total amount of the blood is sending him two letters [7]13 (Fig.11). spent for the nourishment of all the organs of a living body and that only this little part must be restored daily by the food. By consequence the entire blood mass is constantly the same, which does not at all “vanish” but “circulates”. Moreover the real function of the venal valves is just preventing the blood from any centrifugal movement! 8 – As said above, Harvey illustrated his revolutionary hypothesis by 4 figures, which repeat, correct and improve the first figure of Gerolamo Fabrizi of Acquapendente (Fig. 9): Fig11: Malpighi’s plate added to the second letter. In the caption of the right part of the first figure H is erroneously called “artery” instead of “vein”. 10 – However, in spite of Harvey’s absolutely correct hypothesis and Malpighi’s proof of blood circulation, none of them could realize how and why the venal blood transformed into arterial blood during the lesser circulation heart--heart. They could not find even the faintest solution to this otherwise clearest event owing to their lack of any knowledge of modern Chemistry only founded – as said Fig9: The first two figures of the plate in Harvey above – by Antoine Laurent Lavoisier (1742- treatise De motu cordis et sanguinis in animalibus 1794), who made a really revolutionary [6]. discovery: he succeeded in proving that Figure 1 and Fabrizi’s first figure are the same, respiration is nothing else than a particular sort whilst the second shows the real function of the of “combustion”: the arterial blood – charged valves: should the finger be pressed along a with CO2 during the tract heart-periphery-heart vein, in a direction away from the heart, from – changed into venal blood, which in its turn one node (corresponding to a valve) to the next during the tract heart-lungs-heart discharged (for instance from O to H) the tract OH will be CO2 and charged H2 becoming again arterial emptied of blood and will remain empty blood. This fundamental discovery started the because the valve O prevents it from flowing modern pneumatology and haematology. away from the heart (the subsequent two REFERENCES figures confirm what the second clearly shows: [1] Galen, An in arteriis sanguis contineatur Fig. 10). (Whether blood is contained into the arteries), in Claudii Galeni Opera Omnia Editionem curavit D. Carolus Gottlob KÜHN, Lipsiae, in Officina Libraria Car. Cnoblochii, 1820 ff., IV, 703 ff. [2] Gerolamo Fabrizi da Acquapendente- Delle valvole delle vene, edited by Felice Grondona in Studi e testi di Storia della Medicina (Studies and texts on the History of Medicine), 10 – Università degli Studi, Milan,1966.

[3] Realdi Columbi Cremonensis...De re Fig10: The subsequent two figures (Fig. 3 and Fig. anatomica libri XV (XV books on anatomy by 4) of Harvey’s plate. Realdo Colombo of Cremona), ex typographia 9 – Harvey’s hypothesis was confirmed by Nicolai Bevilaque (from Nicolas Bevilcqua’s Marcello Malpighi by observing, describing press), Venice, 1559. and illustrating the structure of a thinnest slide 13 of a dried of a frog. He informed his Both printed in Bologna in 1661.

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[4] De valvulis membraneis quorundam vasorum, [6] W. Harvey, De motu cordis et sanguinis in etc.(On some membranous valves of certain animalibus (On the movement of the heart and vessels), in Tres orationes, etc., Authore the blood in animals), Wilhelm Fitzer, Salomone Alberto (Salomon Alberti’s three Frankfurt A.M., 1628. discourses, etc.), Nürnberg, 1585. [7] Marcello Malpighi, De pulmonibus, edited by [5] S. Musitelli, The Galilean revolution in Luigi Belloni in Per la fondazione della Europe- The cradle of Urology, History Office Società Italiana di Istochimica, etc. (On the of the European Association of Urology, occasion of the foundation of the Italian Arnhem, 2010, p. 40 ff. society of Histochemistry, etc.), Messina- Palermo, October 1958.

Citation: S. Musitelli, M. A. Bertozzi A Brief Histoical Survey of Blood Movements (from the most ancient civilizations to Harvey and Malpighi). ARC Journal of Nephrology. 2(2):8-13. Copyright: ©Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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